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NPI Code Detail

MEDICARE: GLENCOE REGIONAL HEALTH SERVICES

MEDICARE: GLENCOE REGIONAL HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1275N00000XMedicare Defined Swing Bed Hospital Unit330987MN

General Provider Information

NPI Number : 1194832287
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLENCOE REGIONAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 1805 HENNEPIN AVE NORTH
Second Line :
City : GLENCOE
State : MN
Zip : 55336-1416
Country : US
Telephone Number : 320-864-3121
Fax Number : 320-864-7880
Provider Business Practice Location Address
First Line : 1805 HENNEPIN AVE NORTH
Second Line :
City : GLENCOE
State : MN
Zip : 55336-1416
Country : US
Telephone Number : 320-864-3121
Fax Number : 320-864-7880
Authorized Official
Title or Position : PRESIDENT CEO
Name : MR. JON D BRABAND
Credential :
Telephone Number : 320-864-7752
Provider Enumeration Date : 08/24/2006
Last Update Date : 08/22/2020

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1205824752 — JOHN HOWARD BERGSENG DO
Practice Location Address:
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1669460721 — AMIE C SCANTLIN DPM
Practice Location Address:
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1649268707 — PETER THOMAS SMYTH MD
Practice Location Address:
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55336-1416
Practice Phone: 320-864-3121
Practice Fax: 320-864-7887
1356339436 — BRYAN TUTT PETERSEN MD
Practice Location Address:
1805 HENNEPIN AVE N , GLENCOE REGIONAL HEALTH SERVICES
GLENCOE, MN
55336-1416
Practice Phone: 320-864-3121
Practice Fax: 320-864-7887

Directions to “GLENCOE REGIONAL HEALTH SERVICES ” Practice Location

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